Pubdate: Sat, 18 Dec 2000
Source: British Medical Journal (UK)
Copyright: 2000 by the British Medical Journal.
Contact:  http://www.bmj.com/
Author: Kari Poikolainen
Note: The author is the research director for the Finnish Foundation for 
Alcohol Studies, Helsinki, Finland

DRUG USE AND PRISONS: AN INTERNATIONAL PERSPECTIVE

Drug Use and Prisons: An International Perspective Eds David Shewan, John B
Davies Harwood Academic, 19 [pounds sterling], pp 256 ISBN 90 5823 004X

Rating: *

Illicit psychoactive drugs agitate minds and arouse passions even among 
non-users. The public debate is dominated by high emotions, strong 
simplifications, and immutable views. It is therefore refreshing to read 
Drugs: Dilemmas and Choices, a lucidly written book summarising major 
research findings which discusses various policy options, ranging from 
trying to keep the status quo to different degrees of legalisation, and 
which keeps an open mind.

The content of the book mirrors the multifaceted nature of the drug 
problem. After a brief presentation of the most important drugs, there is a 
historical overview of the recreational use of drugs and efforts to control 
their use, spanning from Sumerian beer drinking to the current epidemics of 
heroin, ecstasy, and crack cocaine. There is a balanced discussion of the 
complex causes of drug use, and good reviews of the consequences and 
treatment of drug use. The latest references are from 1999. Unfortunately, 
not all factual statements have been backed up by evidence. Captivating and 
thought provoking topics include the international drug trade, the 
international and national efforts to prevent and control drug use, and the 
dynamics of major epidemics, from gin drinking in 17th century England to 
today's "war on drugs" in the United States.

One of the book's recommendations is that, within Britain's current 
expenditure on tackling drug problems, funding for treatment should be 
increased and activities of customs and the police decreased. This 
recommendation is based on there being evidence that methadone maintenance 
treatment decreases illicit drug use and crime but there being no such 
evidence for law enforcement.

Lack of evidence is, however, a weak argument for relaxing control efforts. 
Would it not be better first to try to acquire evidence for the 
effectiveness of various law enforcement methods? Historical evidence 
suggests that law enforcement has been useful in the control of alcohol, 
tobacco, amphetamine, and opioids. When British Customs and Excise says 
that it can intercept only 5-10% of the drugs entering the country, there 
is room for applying more intensive control efforts and evaluating their 
effects.

One puzzling contradiction is that the RAND Corporation in the United 
States found that treatment was more effective in reducing cocaine use than 
any type of law enforcement, whereas this book concludes that no treatment 
for cocaine dependence has been conclusively shown to be effective in 
producing sustained abstinence.

Another recommendation is that efforts with proved effectiveness should be 
favoured and that those that have been shown to be ineffective should be 
stopped. The ineffectiveness of school based drug education could have been 
stated more emphatically. There is clear evidence that such programmes, 
except those against cigarette smoking, do not work and may sometimes cause 
harm.

How should we deal with the drug problem? Unfortunately, as the authors 
conclude, there are no easy answers. We need more research, social 
experiments of various policy options, and a well informed public debate.

An excellent start to this debate would be to read this book. I'd love to 
see an enlarged, updated, and thoroughly referenced second edition. The 
drug problem is likely to be with us for some time, and this book could 
continue to be a cornerstone of all policy discussions.

Illicit use of psychoactive drugs, HIV infection, hepatitis B, and 
hepatitis C have been observed among prisoners for decades. Drug Use and 
Prisons: An International Perspective gives an idea of how large these 
problems have become and how little has been done to prevent and treat them.

Case reports from several countries show that prisons are not doing all 
they could and should. This multiauthor book has chapters describing the 
situation in Australia, Brazil, Germany, the Netherlands, Switzerland, 
sub-Saharan Africa, Britain, and the United States. However, there is no 
justification given for choosing only these countries.

The responses to drug problems vary greatly. The hard core Swiss addict may 
legitimately have his or her dose of heroin. The United States, with its 
thriving prison industry with over a million clients, has many kinds of 
behavioural treatment projects, but not a word is said about methadone 
maintenance or needle exchange programmes. Are such interventions 
incompatible with US "zero tolerance" ideology?

Most of the chapters are clearly written, although some are heavy to read 
because of data overload. Several chapters lack summaries and conclusions. 
Lack of vigorous editing makes the reader's task burdensome, although the 
content is informative. This is definitely only for those who need 
specialist level information on health problems in prisons.

Ratings are on a 4 star scale, 4=excellent

Kari Poikolainen research director, Finnish Foundation for Alcohol Studies, 
Helsinki, Finland
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